High school athletes required 1 month of recovery after concussion
Click Here to Manage Email Alerts
Published results showed high school athletes required 1 month of recovery after concussion before returning to sport, with longer recovery time among female athletes, players with a history of concussion and those with a delayed diagnosis.
Toufic R. Jildeh, MD, and colleagues collected demographic data, return to sport and concussion-related variables of 357 youth patients who sustained concussions between September 2013 and December 2016. Researchers also collected immediate post-concussion assessment and cognitive testing (ImPACT) metrics of verbal memory, visual memory, motor speed, reaction time, impulse control and cognitive efficiency index, and symptom scores at baseline and following concussions.
Prior to return to sport, high school athletes required approximately 30 days of recovery, while athletes with recurrent concussions required approximately 35 days of rest, according to Jildeh.
“This finding showed agreement with more recent studies that high school athletes return to play in 30 days, which suggests compliance with contemporary return-to-play guidelines,” Jildeh told Healio Orthopedics. “Furthermore, the increased return-to-play time required by those who sustained a repeat concussion suggests that prior concussions may have lingering effects and that incomplete recovery may cause additive cortical and subcortical pathogenesis.”
For athletes who sustained multiple concussions during the study period, results showed an increase in mean ImPACT verbal memory and visual memory scores between baseline ImPACT scores and ImPACT scores after one and two concussions. Athletes with a history of concussion had a significant increase in visual memory vs. athletes without a concussion, according to results. Jildeh noted this suggests patients gain familiarity and comfort with ImPACT testing after sustaining multiple concussions, allowing patients to perform the memory tasks more accurately and expeditiously.
“When evaluating other ImPACT scores more representative of cognitive function, our study found a reliable decline in average visual motor speed and reaction time,” Jildeh said. “These ImPACT domains are not as susceptible to learning, and thus show a dose-related decrease in score as athletes sustain repeated concussions. Orthopedic surgeons must be mindful of this phenomenon when evaluating patients for return-to-play readiness.”
Athletes with a history of concussion, female patients and patients diagnosed in the clinic had significantly longer return-to-sport times, according to results of a multivariable linear model that controlled for possible covariates.
“These findings suggest that athletes with delayed diagnosis and longer return to sport lead to delayed initiation of treatment, and this underscores the importance of vigilance and prompt diagnosis of concussions, particularly for orthopedic surgeons taking care of these patients, whether they are on the sidelines or tending to a patient sustaining a head injury during a trauma,” Jildeh said.
Perspective
Back to Top
Anikar Chhabra, MD
With more than 8 million high school athletes, this paper is valuable to understand the epidemiology of concussions and return- to-sport data in this cohort. There is a substantial difference in return to sport between high school and adult populations, with the mean return to sport of approximately 30 days in adolescents compared to less than a week in professional athletes. Additionally, this study demonstrated that female patients, those with a previous concussion and patients diagnosed in-clinic rather than in-game had a longer time to return to sport.
Following a concussion, the standard of care for return to sport is a graduated program that consists of the following: 1) asymptomatic, 2) normal physical exam (including balance), 3) neurocognitive testing back to baseline and 4) graduated exertional progression for 3 to 6 days. This paper uses this standard protocol.
Historically, it was thought that younger people recovered quicker without complications from concussions due to the plasticity of the brain, but recent evidence confirms this paper’s findings to disprove this. Using this data about a longer return to sport for adolescents, it is critical to educate patients, coaches, parents and athletic trainers. Understanding the potential time missed before injury can help set expectations. This can mitigate potential disasters of returning too soon, such as second-hit phenomenon and permanent long-term sequelae.
The present study utilized ImPACT neurocognitive testing to assess for concussion and track progress. Several other neurocognitive testing systems are available. The most important factor is not the type of neurocognitive testing used, but rather that the neurocognitive testing is understood and sequentially used for a return back to baseline. Remember, neurocognitive testing should solely not be used to determine return-to-sport criteria, but is only one piece of the equation. Don’t forget about an accurate history and physical exam.
Remember the main point: “The adolescent brain is still developing and takes longer to recover than the adult brain.”
Collapse
Read more about
Click Here to Manage Email Alerts